WO2005105202A1 - Methode et systeme de blocage nerveux - Google Patents

Methode et systeme de blocage nerveux Download PDF

Info

Publication number
WO2005105202A1
WO2005105202A1 PCT/GB2005/001682 GB2005001682W WO2005105202A1 WO 2005105202 A1 WO2005105202 A1 WO 2005105202A1 GB 2005001682 W GB2005001682 W GB 2005001682W WO 2005105202 A1 WO2005105202 A1 WO 2005105202A1
Authority
WO
WIPO (PCT)
Prior art keywords
blocking
stimulus
current
nerve
electrode system
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/GB2005/001682
Other languages
English (en)
Inventor
Brian James Andrews
Richard P. Williamson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Brunel University London
Original Assignee
Brunel University London
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Brunel University London filed Critical Brunel University London
Publication of WO2005105202A1 publication Critical patent/WO2005105202A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36007—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of urogenital or gastrointestinal organs, e.g. for incontinence control
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
    • A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
    • A61N1/36071—Pain

Definitions

  • the present invention relates to a method and system for blocking nerves.
  • Anaesthetic nerve blocking agents can be injected directly around nerves to reduce pain for example.
  • the injections are themselves painful and have time limited effect.
  • they cannot be switched off at will and need to be administered by a healthcare professional.
  • a patient suffering from chronic pain can only receive intermittent pain relief from local anaesthetic and must use systemic drugs with undesirable side effects.
  • An electrical stimulus pulse causes bidirectional action potentials (i.e. where one orthodromic action potential travels towards the neuromuscular junction and one antidromically towards the soma), the antidromic action potential will collide with any natural action potentials and effectively cancel them out so that they do not reach the muscle fibre.
  • anodal blockade can be used to cancel the orthodromic action potential.
  • this type of collision blockade requires regular antidromic action potentials in order to maintain the portion of the axon between the soma and the tripolar cuff blocked. The frequency of these antidromic pulses increases as the distance between the tripolar cuff and the soma decreases.
  • the present invention seeks to overcome one or more of the above disadvantages.
  • a device for controlling nerve activity in vivo comprising: a current generator operable to produce current pulses having a cyclical waveform, a plurality of blocking electrode systems electrically connectable to the current generator, each blocking electrode system being operable to deliver a current to the axon of a nerve at a site on the axon and to block the propagation of action potentials in the axon only at that site, a stimulus electrode system for delivering a stimulus pulse to the axon to generate action potentials in the axon, the stimulus electrode being connectable to the current generator, wherein the electrodes being arranged so that the stimulus electrode system is central and flanked on either side by a blocking electrode system.
  • Each blocking electrode system may have its own current generator circuit.
  • One or more of the blocking electrode systems or the stimulus electrode system may comprise a ring electrode.
  • At least one blocking electrode system is provided on a cuff. This arrangement is easy to apply to the nerve.
  • the blocking electrode systems and stimulus electrode system may be provided on a single cuff. This means that only a single cuff has to be applied to the nerve at a single time which speeds up the procedure and reduces the chance of damaging the nerve.
  • the blocking electrode system on at least one side of the stimulus electrode system is a tripolar electrode and most preferably the blocking electrode systems on both sides of the stimulus electrode system are tripolar.
  • Tripolar electrodes provide a uniform field distribution which is important for localised block. This is not achieved with monopolar electrodes.
  • the stimulus electrode system may be bipolar or tripolar (to ensure that all stimulating current is contained within the rings).
  • the return electrode ring(s) of the stimulus ring electrode system may be shared with a neighbouring blocking electrode ring system.
  • the stimulus electrode system is connected to a current generator circuit which is separate from the blocking current generator circuit.
  • the device further comprises a signal amplifier and an electroneurogram cuff electrically connectable thereto.
  • the device may further comprise a control device operable to control the outputs of the current generator.
  • a method of controlling nerve activity in a mammal comprising the steps of: applying stimulus electrical pulses to a first site on the nerve to generate action potentials in the nerve, applying blocking current pulses to a second site on the nerve, the pulses having a cyclical waveform so that application of the pulses blocks the propagation of action potentials in the nerve only at that site, reducing the blocking current amplitude so that the propagation of action potentials remains blocked in some axons but is no longer blocked in pre-selected axons.
  • the block is first removed in smaller diameter axons.
  • the blocking current may be from 0.5 to 50 mA, preferably from 5 to 20mA and most preferably about 10mA.
  • the blocking current may be reduced by up to 70%, preferably by up to 50%, and most preferably by up to 30%.
  • the frequency of the blocking current may be from 5 to 30 Hz, preferably from 11 to 20 Hz.
  • the blocking current is applied distal to the site where the stimulus pulses are applied.
  • the blocking current is applied proximal to the stimulus pulses so that propagation back to the spinal cord is blocked.
  • the blocking current may also be applied distal to the stimulus pulses, whereby the proximal current is maintained to block the propagation of action potentials at that site and the distal current is reduced so that the propagation of action potentials remains blocked in some axons but is no longer blocked in pre-selected axons.
  • the frequency of the stimulus pulses may be from 5 to 30 Hz, and preferably about 15 Hz.
  • the blocking and stimulus pulses may be applied to the pudendal, S2, S3, tibial and / or a trigeminal nerve.
  • the method may further comprise the step of subsequently increasing the frequency of stimulus pulses to at least 30 Hz to induce cell death. This can be used to selectively kill pain fibres.
  • Figure 1 shows an embodiment of experimental set-up
  • Figure 2 a typical force muscle block
  • Figure 3 shows twitches generated by proximal stimuli
  • Figure 4 shows possible stimulus/block combinations
  • Figure 5 shows an example of blocking sequence
  • Figure 6 shows an embodiment of block stimulation electrode system.
  • Figure 7 shows the reduction in muscle force from decreased sinusoidal current amplitude.
  • mice Five female rats (307 +/- 40 g) were tested. Each rat was anaesthetised with an intraperitoneal injection of 45 mg/kg pentobarbital sodium (Somnotol). After initial anaesthesia, pentobarbital sodium (45 mg/kg ip) was administered in a 1:5 dilution to maintain general anaesthesia. The trachea of each rat was cannulated and mechanical ventilation assistance was applied for one animal. The body of each rat was warmed during the tests by radiant heat from above and a heating pad beneath.
  • pentobarbital sodium Somnotol
  • pentobarbital sodium 45 mg/kg ip
  • the left sciatic nerve was exposed in each rat.
  • the ipsilateral knee was held in place using a stereotaxic frame.
  • Each ipsilateral muscle group, other than the tibialis anterior, was denervated.
  • the tendon from the tibialis anterior was cut and tied to a strain gauge.
  • Force was amplified and viewed on a Tektronix dual time base storage oscilloscope (model 5441), and monitored continuously on a Gould 1200S pen recorder. The force from the muscle was recorded under different stimulus conditions.
  • a bipolar cuff electrode constructed of silastic tubing (inside diameter 1.98 mm outside diameter 3.18 mm, length 6 mm, contacts of 15 strand Cooner wire symmetrically and longitudinally spaced by 4 mm) was placed around the sciatic nerve at the most distal site from the muscle.
  • An intramuscular electrode made by bared ends of TeflonTM coated fine silver wires (75 ⁇ m), was inserted near the motor point of the tibialis anterior in a position most proximal to the muscle.
  • a symmetrical tripolar cuff electrode (inside diameter 1.98 mm outside diameter 3.18 mm, length 6 mm, contacts of 15 strand Cooner wire symmetrically spaced by 2 mm) was placed around the common peroneal nerve approximately halfway between the other two electrodes.
  • the tripolar cuff has a central cathode flanked by a pair of anodes.
  • Action potentials and muscle firings were produced using unipolar 50 ⁇ s pulses produced by a Grass stimulus generator and connected to the bipolar and intramuscular electrodes.
  • the amplitude of the pulses (typically 5 to 10 Volts) was set to cause the maximal force single muscle twitch from the muscle.
  • Pulses could be generated independently from the bipolar and intramuscular electrode, or the timing of the pulses could be synchronised.
  • the muscle twitch produced by the intramuscular electrode typically preceded the muscle twitch from the cuff electrode by one second. In some tests, only the bipolar electrode was used to generate action potentials.
  • the centre contact of the cuff was connected to a variable frequency, variable amplitude alternating current sinusoidal waveform generator.
  • the two outer contacts of the tripolar cuff electrode were connected to the common (ground) of a sinusoidal stimulator.
  • the waveform generator used an analogue control to vary the frequency between 3 and 20 kHz block could typically be established with frequencies above 7kHz.
  • the magnitude of the first harmonic of the sine waveform, the largest frequency domain component of noise, was attenuated by 38 dB, measured on a Hewlett Packard digital storage oscilloscope, Model 54600A.
  • Figure 2 is a typical muscle force record for block above 10 kHz.
  • the larger series of muscle twitches was due to the bipolar cuff electrode and the second twitch the intramuscular electrode.
  • a larger twitch is observed on turning on the block sine current which is applied in the region of the tripolar electrode.
  • the tripolar cuff electrode is located downstream of the proximal bipolar cuff electrode and upstream of the intramuscular electrode.
  • the blocking effect is localised to the tripolar cuff region; the current path is entirely contained within the length of the cuff.
  • the block prevents pulses from the proximal bipolar cuff reaching the muscle. After the block has been switched off both stimulus twitches immediately resume. In other words, the block has a rapid onset and is immediately reversible.
  • FIG. 3 An example of selective stimulation is shown in Figure 3, in which muscle twitches were generated at 5 s intervals by the proximal bipolar cuff stimuli.
  • the sinusoidal current was applied at 2.4mA, a current found to produce complete blockade of the nerve. No muscle activity was observed indicating that all axons are blocked.
  • the blocking current is then reduced and then increased to its original value over a period of 50 seconds. It is observed that single twitches were observed with amplitude inversely proportional to sine current. The smallest axons are first to unblock and can transmit signals to the muscle fibres, thus some twitching is seen.
  • the sinusoidal current is then progressively increased again to maximum, so that all the axons are blocked, and held blocked at maximum until the sinusoidal blocking current is switched off.
  • This selective stimulation of axons is useful for example in bladder control.
  • the S2 spinal nerve root innervates both the smooth muscle of the detrusor (bladder) and the external sphincter muscle (which is skeletal muscle).
  • the bladder is innervated by axons with a smaller diameter than the axons that innervate the sphincter muscle.
  • a supramaximal stimulus were applied to this spinal root both detrusor and sphincter would contract.
  • a blocking tripolar cuff is positioned distally with respect to this point of stimulation, the sinusoidal blocking current could be set a level which blocks signals to the external sphincter but not the detrusor muscle.
  • the detrusor would contract and the sphincter relax which would assist micturition.
  • an intramuscular electrode is not required.
  • the stimulus generates action potentials in both directions in a population of axons determined by the stimulus intensity.
  • the sinusoidal current can be adjusted to selectively block propagation in the larger axons to the right. For example, this could be used to activate the smaller axons of the detrusor whilst blocking the sphincter as described above.
  • This arrangement would require both large and small axons to be activated and action potentials can travel back to the spinal cord which may cause unwanted sensation or reflex actions. This can be prevented in the following arrangement.
  • Figure 4(c) is used to establish uni-directional activation only in the smaller axons. It uses an arrangement with two tripolar cuffs to apply block in two regions either side of a point of stimulation (typically a biopolar electrode pair).
  • the stimulus intensity is set to a sufficiently high level (such as up to 20mA) so that all axons are stimulated and action potentials travel bidirectionally.
  • the right block current is set to level just sufficient to block the larger (sphincter) axons .
  • the sinusoidal blocking current of the left blocking cuff is set sufficiently high so as to block all axons.
  • the method can be applied vice versa for propagation to the left.
  • this method could be carried out using a single cuff with up to eight electrodes (two tripolar blocks with a central bipolar). The number of electrodes can be reduced to six (to produce a shorter cuff length) with the two central electrodes could apply the stimulus pulse and the other electrodes apply a blocking current.
  • the block and stimulus electrodes may be in close proximity. This means the arrangement is very compact and less of the nerve must be exposed to put it in position.
  • Figure 7 shows a reduction in muscle force from decreased simusoidal current amplitude.
  • Major divisions of the ordinate axis are 0.5 V recorded from the strain gauge transducer.
  • Single muscle twitches are generated from pulses delivered to the bipolar cuff electrode. 3mA of 15-kHz sinusoidal current was applied at time TO. After the transient contraction, the muscle twitches due to bipolar cuff electrode pulses ceased, indicating a complete conduction block through the area of the sinusoidal current.
  • the amplitude of the sinusoidal current was reduced between times Tl and T2 to 1.5mA. Initially, the decrease in amplitude did not permit any of the compound action potential to propagate.
  • the AC block may be used in combination with an ENG (electroneurogram) cuff and signal amplifier to selectively record from smaller axons by first blocking activity in the larger axons as shown in Figure 5. Without blocking the larger axons, it would be difficult to seperate the signals from the smaller axons since larger signals are produced by action potentials in the larger diameter axons and would dominate the reading.
  • ENG electrotroneurogram
  • a blocking cuff electrode could be positioned on the pudendal nerve (a branch of the S2 nerve) or on the S2 nerve itself to transiently block activity in the sphincters, which may be used assist micturition or defecation. This is useful where the sphincter does not relax when the bladder or bowel contracts.
  • the same cuff could also double-up as a stimulating electrode to provide low-level neuromodulation during the filling phases to reduce hyperactivity in the detrusor or rectum.
  • the blocking cuff is positioned extradurally on the mixed sacral root (typically S3) as shown in Figure 6 following a similar surgical procedure to that used in the "Barcelona" technique [Sarrias M, Sarrias F, Borau A(1993) The Barcelona technique, Neurol & Urodyn, vol 12, p509-512.].
  • the block/stimulation electrode system of Figure 4 (a) or (c) is positioned extradurally and bilaterally on the mixed sacral roots. The approximate location for S2 cuff electrode system is indicated.
  • a stimulating electrode system is positioned distally.
  • the stimulus is applied in bursts at typically 15Hz to provide post-stimulus voiding similar to that used in the FineTech-Brindley SARS system.
  • the AC block would temporarily disrupt the reflex arc during micturition thus avoiding detrusor-sphincter-dyssynergia.
  • the block is switched off and a low- level stimulation applied at typically 20Hz to provide neuromodulation to reduce detrusor hyperreflexia.
  • the method does not induce action potentials in sensory axons (which in some spinal cord injury patients can give rise to dangerous reflexs such as autonomic dysreflexia), it can also be used in patients to neurological disorders with some sensory sparing, such as incomplete spinal injuries or MS.
  • the system can also be used in cerebral palsy patients. Such patients suffer involuntary spasms.
  • the calf muscle contracts so that the foot is plantar flexed during the terminal swing phase of the walking cycle. Thus the foot lands on the toes instead of the heel. This contraction leads to deformity.
  • the system can be used by the patient to block the tibial nerve in key points in the walking cycle.
  • the system can also be used in pain control by blocking sensory rather than motor nerves.
  • the system could be used on the trigeminal nerves in the face to alleviate trigeminal neuralgia.
  • the nerve to be blocked is exposed and a tripolar electrode cuff is placed around the nerve.
  • a stimulus electrode cuff is put in place either upstream or downstream of the tripolar electrode.
  • a neural prosthesis is implanted just below the skin and wires run from the prosthesis to the electrodes.
  • the prosthesis has an RF receiver circuit and is powered by an external RF source.
  • the prosthesis may have a rechargeable battery.
  • the cuff electrode contains the RF receiver circuits.
  • the patient then carries a control device which he can operate to transmit signals to the electrodes in order to block and/or stimulate the nerve activity.
  • the current required to block a nerve depends on several factors such as the diameter of the axon and how slack the cuff is on the nerve. This may alter over time as fibrous tissue can begin to grow between the nerve and the cuff.
  • the control device may monitor the impedance of the system and automatically adjust the current settings accordingly. The current required is also species dependent.
  • Another application of the method is to destroy signal sensory neurons involved in the pain pathway such as C fibres and A ⁇ fibres. Activity in the larger axons could be blocked and then a high frequency stimulus (such as 50Hz or more) applied to the small axons to induce cell death by mechanisms similar to those described by Agnew & McCreary. This would be particularly advantageous for people suffering from chronic pain.
  • a high frequency stimulus such as 50Hz or more
  • the method and system can be used in clinical and veterinary applications.
  • the tripolar cuff is a silicon rubber sheet with three electrodes embedded therein. Those commonly used are 'self-curl' or self-sizing'. The sheet is positioned by the nerve and it seals around the nerve forming a tube. Alternatively, a rubber tube is opened up, put in place around the nerve and then the tube is resealed. The cuff is oversized (compared to the nerve diameter) by about 20-50%. This is so the cuff does not compress the nerve and cause damage.
  • the tripolar cuff may be a silicon rubber sheet with three electrodes embedded therein. Alternatively, the cuff may comprise a polyamide film with the electrodes printed thereon (Blocking of peripheral nerve conduction using AC signals: Which frequency is best? Schuettler, M Andrews, BJ 2 , Donaldson, NdeN ⁇ roc 9 th Ann Sci Conf IFESS, Bounemouth UK, Sept 2004)
  • cuffs are 'self-curl' or self-sizing'.
  • the sheet is positioned by the nerve and it seals around the nerve forming a tube.
  • a rubber tube is opened up, put in place around the nerve and then the tube is resealed.
  • the cuff is oversized (compared to the nerve diameter) by about 20-50%). This is so the cuff does not compress the nerve and cause damage.
  • the blocking electrode may have more than three electrodes in order to produce a uniform field distribution. However, using fewer than three electrodes, such as a bipolar arrangement does not produce a uniform electrical field and hence no localised block.
  • the electrodes may be stainless steel. However, platinum iridium electrodes are preferred as stainless steel will eventually pit with higher current levels.
  • the electrodes in the tripolar cuff are about 2mm apart in a cuff having an internal diameter of approximately 2mm. The cuff diameter is dependent on the nerve diameter. The larger the diameter of the nerve, the larger the internal diameter of the cuff. Details including examples are provided in Richard P. Williamson and Brian J. Andrews, IEEE transactions on Biomedical Engineering Vol. 52, No. 3, March 2005, and BJ Andrews and R. Williamson, AC Nerve Blocking: in-viro tests and potential applications, 9th Annual Conference of the International FES Society, pages 11-13, September 2004, Bournemouth, UK.
  • the blocking current is sinusoidal, merely that it is cyclical.
  • Other waveforms could be used such as square or rectangular waves.

Landscapes

  • Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Pain & Pain Management (AREA)
  • Neurology (AREA)
  • Neurosurgery (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Electrotherapy Devices (AREA)

Abstract

L'invention concerne un dispositif destiné au soulagement de la douleur, au contrôle des intestins et de la vessie. Ledit dispositif comprend un générateur d'impulsions de forme d'onde cycliques, des systèmes à électrodes pour le blocage de la propagation de potentiels d'action dans l'axone, uniquement au niveau du site, et un système à électrodes de stimulus afin d'engendrer des potentiels d'action dans l'axone. Ledit système à électrodes de stimulus est central et flanqué sur un des côtés par un système à électrodes de blocage. Après application d'impulsions électriques de stimulus au niveau d'un premier site sur le blocage nerveux, des impulsions d'onde de forme cycliques sont appliquées sur un second site sur le nerf. Puis, l'amplitude du courant de blocage est diminuée de telle manière que la propagation des potentiels d'action reste bloquée dans certains axones, mais elle n'est plus bloquée dans des axones présélectionnées.
PCT/GB2005/001682 2004-04-30 2005-05-03 Methode et systeme de blocage nerveux Ceased WO2005105202A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0409806A GB0409806D0 (en) 2004-04-30 2004-04-30 Nerve blocking method and system
GB0409806.7 2004-04-30

Publications (1)

Publication Number Publication Date
WO2005105202A1 true WO2005105202A1 (fr) 2005-11-10

Family

ID=32482549

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2005/001682 Ceased WO2005105202A1 (fr) 2004-04-30 2005-05-03 Methode et systeme de blocage nerveux

Country Status (2)

Country Link
GB (1) GB0409806D0 (fr)
WO (1) WO2005105202A1 (fr)

Cited By (34)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012159002A2 (fr) 2011-05-19 2012-11-22 Neuros Medical, Inc. Blocage de nerf électrique haute-fréquence
US8412336B2 (en) 2008-12-29 2013-04-02 Autonomic Technologies, Inc. Integrated delivery and visualization tool for a neuromodulation system
US8473062B2 (en) 2008-05-01 2013-06-25 Autonomic Technologies, Inc. Method and device for the treatment of headache
US8494641B2 (en) 2009-04-22 2013-07-23 Autonomic Technologies, Inc. Implantable neurostimulator with integral hermetic electronic enclosure, circuit substrate, monolithic feed-through, lead assembly and anchoring mechanism
WO2013156125A1 (fr) 2012-04-17 2013-10-24 Merck Patent Gmbh Polymères réticulables et polymères réticulés, leurs procédés de préparation et leur utilisation
WO2016011512A1 (fr) * 2014-07-25 2016-01-28 Saluda Medical Pty Ltd Dosage de stimulation neurale
US9320908B2 (en) 2009-01-15 2016-04-26 Autonomic Technologies, Inc. Approval per use implanted neurostimulator
US9872990B2 (en) 2011-05-13 2018-01-23 Saluda Medical Pty Limited Method and apparatus for application of a neural stimulus
US9974455B2 (en) 2011-05-13 2018-05-22 Saluda Medical Pty Ltd. Method and apparatus for estimating neural recruitment
US10206596B2 (en) 2012-11-06 2019-02-19 Saluda Medical Pty Ltd Method and system for controlling electrical conditions of tissue
US10278600B2 (en) 2011-05-13 2019-05-07 Saluda Medical Pty Ltd. Method and apparatus for measurement of neural response
US10368762B2 (en) 2014-05-05 2019-08-06 Saluda Medical Pty Ltd. Neural measurement
US10426409B2 (en) 2013-11-22 2019-10-01 Saluda Medical Pty Ltd Method and device for detecting a neural response in a neural measurement
US10500399B2 (en) 2014-12-11 2019-12-10 Saluda Medical Pty Ltd Method and device for feedback control of neural stimulation
US10568559B2 (en) 2011-05-13 2020-02-25 Saluda Medical Pty Ltd Method and apparatus for measurement of neural response
US10588698B2 (en) 2014-12-11 2020-03-17 Saluda Medical Pty Ltd Implantable electrode positioning
US10588524B2 (en) 2011-05-13 2020-03-17 Saluda Medical Pty Ltd Method and apparatus for measurement of neural response
US10758723B2 (en) 2011-05-19 2020-09-01 Neuros Medical, Inc. Nerve cuff electrode for neuromodulation in large human nerve trunks
US10849525B2 (en) 2015-05-31 2020-12-01 Saluda Medical Pty Ltd Monitoring brain neural activity
US10894158B2 (en) 2015-04-09 2021-01-19 Saluda Medical Pty Ltd Electrode to nerve distance estimation
US10918872B2 (en) 2015-01-19 2021-02-16 Saluda Medical Pty Ltd Method and device for neural implant communication
US11006846B2 (en) 2014-11-17 2021-05-18 Saluda Medical Pty Ltd Method and device for detecting a neural response in neural measurements
US11006857B2 (en) 2015-06-01 2021-05-18 Closed Loop Medical Pty Ltd Motor fibre neuromodulation
US11110270B2 (en) 2015-05-31 2021-09-07 Closed Loop Medical Pty Ltd Brain neurostimulator electrode fitting
US11116965B2 (en) 2017-12-13 2021-09-14 Neuros Medical, Inc. Nerve cuff deployment devices
US11172864B2 (en) 2013-11-15 2021-11-16 Closed Loop Medical Pty Ltd Monitoring brain neural potentials
US11179091B2 (en) 2016-06-24 2021-11-23 Saluda Medical Pty Ltd Neural stimulation for reduced artefact
US11191966B2 (en) 2016-04-05 2021-12-07 Saluda Medical Pty Ltd Feedback control of neuromodulation
US11213682B2 (en) 2018-04-09 2022-01-04 Neuros Medical, Inc. Apparatuses and methods for setting an electrical dose
US11413458B2 (en) 2011-05-19 2022-08-16 Neuros Medical, Inc. Nerve cuff electrode for neuromodulation in large human nerve trunks
US11878172B2 (en) 2020-02-11 2024-01-23 Neuros Medical, Inc. System and method for quantifying qualitative patient-reported data sets
US11944820B2 (en) 2018-04-27 2024-04-02 Saluda Medical Pty Ltd Neurostimulation of mixed nerves
US12285263B2 (en) 2014-03-28 2025-04-29 Saluda Medical Pty Ltd Assessing neural state from action potentials
US12343147B2 (en) 2012-11-06 2025-07-01 Saluda Medical Pty Ltd Method and system for controlling electrical conditions of tissue II

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1004330A1 (fr) * 1998-11-25 2000-05-31 Medtronic, Inc. Procédé et système de stimulation pour le traitement des affections du reflux gastro-oesophagien
US20020055779A1 (en) * 1996-03-05 2002-05-09 Brian J. Andrews Neural prosthesis
US20030004553A1 (en) * 2001-03-30 2003-01-02 Case Western Reserve University Systems and methods for selectively stimulating components in, on, or near the pudendal nerve or its branches to achieve selective physiologic responses
WO2004000416A1 (fr) * 2002-06-20 2003-12-31 Advanced Bionics Corporation Microstimulateurs implantables pour la propagation unidirectionnelle de potentiels d'action

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020055779A1 (en) * 1996-03-05 2002-05-09 Brian J. Andrews Neural prosthesis
EP1004330A1 (fr) * 1998-11-25 2000-05-31 Medtronic, Inc. Procédé et système de stimulation pour le traitement des affections du reflux gastro-oesophagien
US20030004553A1 (en) * 2001-03-30 2003-01-02 Case Western Reserve University Systems and methods for selectively stimulating components in, on, or near the pudendal nerve or its branches to achieve selective physiologic responses
WO2004000416A1 (fr) * 2002-06-20 2003-12-31 Advanced Bionics Corporation Microstimulateurs implantables pour la propagation unidirectionnelle de potentiels d'action

Cited By (79)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8473062B2 (en) 2008-05-01 2013-06-25 Autonomic Technologies, Inc. Method and device for the treatment of headache
US8412336B2 (en) 2008-12-29 2013-04-02 Autonomic Technologies, Inc. Integrated delivery and visualization tool for a neuromodulation system
US9554694B2 (en) 2008-12-29 2017-01-31 Autonomic Technologies, Inc. Integrated delivery and visualization tool for a neuromodulation system
US8781574B2 (en) 2008-12-29 2014-07-15 Autonomic Technologies, Inc. Integrated delivery and visualization tool for a neuromodulation system
US9320908B2 (en) 2009-01-15 2016-04-26 Autonomic Technologies, Inc. Approval per use implanted neurostimulator
US8886325B2 (en) 2009-04-22 2014-11-11 Autonomic Technologies, Inc. Implantable neurostimulator with integral hermetic electronic enclosure, circuit substrate, monolithic feed-through, lead assembly and anchoring mechanism
US8494641B2 (en) 2009-04-22 2013-07-23 Autonomic Technologies, Inc. Implantable neurostimulator with integral hermetic electronic enclosure, circuit substrate, monolithic feed-through, lead assembly and anchoring mechanism
US11554265B2 (en) 2011-05-13 2023-01-17 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US11464979B2 (en) 2011-05-13 2022-10-11 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US11413460B2 (en) 2011-05-13 2022-08-16 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US11045129B2 (en) 2011-05-13 2021-06-29 Saluda Medical Pty Ltd. Method and apparatus for estimating neural recruitment
US11420064B2 (en) 2011-05-13 2022-08-23 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US11426587B2 (en) 2011-05-13 2022-08-30 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US11439828B2 (en) 2011-05-13 2022-09-13 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US9872990B2 (en) 2011-05-13 2018-01-23 Saluda Medical Pty Limited Method and apparatus for application of a neural stimulus
US11445958B2 (en) 2011-05-13 2022-09-20 Saluda Medical Pty Ltd Method and apparatus for estimating neural recruitment
US9974455B2 (en) 2011-05-13 2018-05-22 Saluda Medical Pty Ltd. Method and apparatus for estimating neural recruitment
US11491334B2 (en) 2011-05-13 2022-11-08 Saluda Medical Pty Ltd Method and apparatus for application of a neural stimulus
US10278600B2 (en) 2011-05-13 2019-05-07 Saluda Medical Pty Ltd. Method and apparatus for measurement of neural response
US11324427B2 (en) 2011-05-13 2022-05-10 Saluda Medical Pty Ltd Method and apparatus for measurement of neural response
US11819332B2 (en) 2011-05-13 2023-11-21 Saluda Medical Pty Ltd Method and apparatus for measurement of neural response
US10588524B2 (en) 2011-05-13 2020-03-17 Saluda Medical Pty Ltd Method and apparatus for measurement of neural response
US10568559B2 (en) 2011-05-13 2020-02-25 Saluda Medical Pty Ltd Method and apparatus for measurement of neural response
US11944440B2 (en) 2011-05-13 2024-04-02 Saluda Medical Pty Ltd Method and apparatus for estimating neural recruitment
AU2012255073A1 (en) * 2011-05-19 2013-10-31 Neuros Medical, Inc. High-frequency electrical nerve block
US10758723B2 (en) 2011-05-19 2020-09-01 Neuros Medical, Inc. Nerve cuff electrode for neuromodulation in large human nerve trunks
US12011597B2 (en) 2011-05-19 2024-06-18 Neuros Medical, Inc. Nerve cuff electrode for neuromodulation in large human nerve trunks
AU2012255073B2 (en) * 2011-05-19 2016-06-30 Neuros Medical, Inc. High-frequency electrical nerve block
EP2709717A4 (fr) * 2011-05-19 2014-10-22 Neuros Medical Inc Blocage de nerf électrique haute-fréquence
WO2012159002A2 (fr) 2011-05-19 2012-11-22 Neuros Medical, Inc. Blocage de nerf électrique haute-fréquence
US11413458B2 (en) 2011-05-19 2022-08-16 Neuros Medical, Inc. Nerve cuff electrode for neuromodulation in large human nerve trunks
US8983612B2 (en) 2011-05-19 2015-03-17 Neuros Medical, Inc. High-frequency electrical nerve block
WO2013156125A1 (fr) 2012-04-17 2013-10-24 Merck Patent Gmbh Polymères réticulables et polymères réticulés, leurs procédés de préparation et leur utilisation
US10206596B2 (en) 2012-11-06 2019-02-19 Saluda Medical Pty Ltd Method and system for controlling electrical conditions of tissue
US11944439B2 (en) 2012-11-06 2024-04-02 Saluda Medical Pty Ltd Method and system for controlling electrical conditions of tissue
US12343147B2 (en) 2012-11-06 2025-07-01 Saluda Medical Pty Ltd Method and system for controlling electrical conditions of tissue II
US11389098B2 (en) 2012-11-06 2022-07-19 Saluda Medical Pty Ltd Method and system for controlling electrical conditions of tissue
US12376780B2 (en) 2013-11-15 2025-08-05 Closed Loop Medical Pty Ltd Monitoring brain neural potentials
US11172864B2 (en) 2013-11-15 2021-11-16 Closed Loop Medical Pty Ltd Monitoring brain neural potentials
US10426409B2 (en) 2013-11-22 2019-10-01 Saluda Medical Pty Ltd Method and device for detecting a neural response in a neural measurement
US11337658B2 (en) 2013-11-22 2022-05-24 Saluda Medical Pty Ltd Method and device for detecting a neural response in a neural measurement
US11890113B2 (en) 2013-11-22 2024-02-06 Saluda Medical Pty Ltd Method and device for detecting a neural response in a neural measurement
US12285263B2 (en) 2014-03-28 2025-04-29 Saluda Medical Pty Ltd Assessing neural state from action potentials
US11457849B2 (en) 2014-05-05 2022-10-04 Saluda Medical Pty Ltd Neural measurement
US12369826B2 (en) 2014-05-05 2025-07-29 Saluda Medical Pty Ltd Neural measurement
US10368762B2 (en) 2014-05-05 2019-08-06 Saluda Medical Pty Ltd. Neural measurement
AU2020277131B2 (en) * 2014-07-25 2023-03-30 Saluda Medical Pty Ltd Neural stimulation dosing
AU2015292272B2 (en) * 2014-07-25 2020-11-12 Saluda Medical Pty Ltd Neural stimulation dosing
US10632307B2 (en) 2014-07-25 2020-04-28 Saluda Medical Pty Ltd Neural stimulation dosing
EP3838331A1 (fr) * 2014-07-25 2021-06-23 Saluda Medical Pty Limited Dosage de stimulation neurale
EP3171929A4 (fr) * 2014-07-25 2018-02-07 Saluda Medical Pty Limited Dosage de stimulation neurale
WO2016011512A1 (fr) * 2014-07-25 2016-01-28 Saluda Medical Pty Ltd Dosage de stimulation neurale
US12409318B2 (en) 2014-07-25 2025-09-09 Saluda Medical Pty Ltd Neural stimulation dosing
US11167129B2 (en) 2014-07-25 2021-11-09 Saluda Medical Pty Ltd Neural stimulation dosing
US12329527B2 (en) 2014-11-17 2025-06-17 Saluda Medical Pty Ltd Method and device for detecting a neural response in neural measurements
US11006846B2 (en) 2014-11-17 2021-05-18 Saluda Medical Pty Ltd Method and device for detecting a neural response in neural measurements
US10500399B2 (en) 2014-12-11 2019-12-10 Saluda Medical Pty Ltd Method and device for feedback control of neural stimulation
US12064632B2 (en) 2014-12-11 2024-08-20 Saluda Medical Pty Ltd Method and device for feedback control of neural stimulation
US10588698B2 (en) 2014-12-11 2020-03-17 Saluda Medical Pty Ltd Implantable electrode positioning
US11464980B2 (en) 2014-12-11 2022-10-11 Saluda Medical Pty Ltd Method and device for feedback control of neural stimulation
US11344729B1 (en) 2014-12-11 2022-05-31 Saluda Medical Pty Ltd Method and device for feedback control of neural stimulation
US11219766B2 (en) 2014-12-11 2022-01-11 Saluda Medical Pty Ltd Method and device for feedback control of neural stimulation
US10918872B2 (en) 2015-01-19 2021-02-16 Saluda Medical Pty Ltd Method and device for neural implant communication
US11938320B2 (en) 2015-04-09 2024-03-26 Saluda Medical Pty Ltd Electrode to nerve distance estimation
US10894158B2 (en) 2015-04-09 2021-01-19 Saluda Medical Pty Ltd Electrode to nerve distance estimation
US11110270B2 (en) 2015-05-31 2021-09-07 Closed Loop Medical Pty Ltd Brain neurostimulator electrode fitting
US10849525B2 (en) 2015-05-31 2020-12-01 Saluda Medical Pty Ltd Monitoring brain neural activity
US11006857B2 (en) 2015-06-01 2021-05-18 Closed Loop Medical Pty Ltd Motor fibre neuromodulation
US12138457B2 (en) 2016-04-05 2024-11-12 Saluda Medical Pty Ltd Feedback control of neuromodulation
US11191966B2 (en) 2016-04-05 2021-12-07 Saluda Medical Pty Ltd Feedback control of neuromodulation
US11179091B2 (en) 2016-06-24 2021-11-23 Saluda Medical Pty Ltd Neural stimulation for reduced artefact
US11826156B2 (en) 2016-06-24 2023-11-28 Saluda Medical Pty Ltd Neural stimulation for reduced artefact
US11116965B2 (en) 2017-12-13 2021-09-14 Neuros Medical, Inc. Nerve cuff deployment devices
US11752331B2 (en) 2017-12-13 2023-09-12 Neuros Medical, Inc. Nerve cuff deployment devices
US12201837B2 (en) 2018-04-09 2025-01-21 Neuros Medical, Inc. Apparatuses and methods for setting an electrical dose
US11213682B2 (en) 2018-04-09 2022-01-04 Neuros Medical, Inc. Apparatuses and methods for setting an electrical dose
US11730963B2 (en) 2018-04-09 2023-08-22 Neuros Medical, Inc. Apparatuses and methods for setting an electrical dose
US11944820B2 (en) 2018-04-27 2024-04-02 Saluda Medical Pty Ltd Neurostimulation of mixed nerves
US11878172B2 (en) 2020-02-11 2024-01-23 Neuros Medical, Inc. System and method for quantifying qualitative patient-reported data sets

Also Published As

Publication number Publication date
GB0409806D0 (en) 2004-06-09

Similar Documents

Publication Publication Date Title
WO2005105202A1 (fr) Methode et systeme de blocage nerveux
US9821157B2 (en) Charge-enhanced neural electric stimulation system
KR101866252B1 (ko) 차지 강화된 신경의 전기적 자극 시스템
EP1981589B1 (fr) Système de routage d'un courant électrique à des tissus corporels par l'intermédiaire de conducteurs passifs implantés
US9072886B2 (en) Method of routing electrical current to bodily tissues via implanted passive conductors
US9037246B2 (en) Electrical stimulation treatment of bronchial constriction
US20100016929A1 (en) Method and system for controlled nerve ablation
US11712566B2 (en) Sacral nerve stimulation
Tator et al. Spinal cord stimulation: therapeutic benefits and movement generation after spinal cord injury
Rijkhoff et al. Acute animal studies on the use of an anodal block to reduce urethral resistance in sacral root stimulation
Middleton et al. Artificial autonomic reflexes: using functional electrical stimulation to mimic bladder reflexes after injury or disease
Hunter Peckham Principles of electrical stimulation
EP2550060B1 (fr) Système de stimulation électrique neuronal avec amélioration de charge
US20230398346A1 (en) Fatigue-resistant electrostimulation leads and methods of use thereof
Prochazka et al. Spinal cord and rootlets
Mathews VALIDATION AND APPLICATION OF A NOVEL HIGH DENSITY ELECTRODE ARRAY FOR USE IN SMALL DIAMETER PERIPHERAL NERVES
KR20080101931A (ko) 이식된 수동 전도체를 통해 신체 조직으로 전류를 전달하는방법
Andrews et al. AC Nerve Blocking: in-vivo tests & potential applications
Veltink et al. Multi-Electrode Stimulation Of Myelinated Nerve Fibers
IL151859A (en) Method and instrument for selective control of nerve fibers

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BW BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EC EE EG ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KM KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NA NI NO NZ OM PG PH PL PT RO RU SC SD SE SG SK SL SM SY TJ TM TN TR TT TZ UA UG US UZ VC VN YU ZA ZM ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GM KE LS MW MZ NA SD SL SZ TZ UG ZM ZW AM AZ BY KG KZ MD RU TJ TM AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IS IT LT LU MC NL PL PT RO SE SI SK TR BF BJ CF CG CI CM GA GN GQ GW ML MR NE SN TD TG

121 Ep: the epo has been informed by wipo that ep was designated in this application
NENP Non-entry into the national phase

Ref country code: DE

WWW Wipo information: withdrawn in national office

Country of ref document: DE

122 Ep: pct application non-entry in european phase